Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 923506
CHAMBER ACTION
Senate House
.
.
1 Comm: FAV .
12/07/2005 12:26 PM .
2 .
.
3 Floor: 8/AD/2R .
12/07/2005 04:43 PM .
4 ______________________________________________________________
5
6
7
8
9
10 ______________________________________________________________
11 The Committee on Ways and Means (Atwater) recommended the
12 following amendment:
13
14 Senate Amendment (with title amendment)
15 On page 37, line 4, through
16 page 38, line 24, delete those lines
17
18 and insert:
19 (7)(a) The Secretary of Health Care Administration
20 shall convene a technical advisory panel to advise the agency
21 in the areas of risk-adjusted-rate setting, benefit design,
22 and choice counseling. The panel shall include representatives
23 from the Florida Association of Health Plans, representatives
24 from provider-sponsored networks, and a representative from
25 the Office of Insurance Regulation.
26 (b) The technical advisory panel shall advise the
27 agency concerning:
28 1. The risk-adjusted rate methodology to be used by
29 the agency, including recommendations on mechanisms to
30 recognize the risk of all Medicaid enrollees and for the
31 transition to a risk-adjustment system, including
1
3:52 PM 12/06/05 s0002Bc1c-wm25-j03
Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 923506
1 recommendations for phasing in risk adjustment and the use of
2 risk corridors.
3 2. Implementation of an encounter data system to be
4 used for risk-adjusted rates.
5 3. Administrative and implementation issues regarding
6 the use of risk-adjusted rates, including, but not limited to,
7 cost, simplicity, client privacy, data accuracy, and data
8 exchange.
9 4. Issues of benefit design, including the actuarial
10 equivalence and sufficiency standards to be used.
11 5. The implementation plan for the proposed
12 choice-counseling system, including the information and
13 materials to be provided to recipients, the methodologies by
14 which recipients will be counseled regarding choice, criteria
15 to be used to assess plan quality, the methodology to be used
16 to assign recipients into plans if they fail to choose a
17 managed care plan, and the standards to be used for
18 responsiveness to recipient inquiries.
19 (c) The technical advisory panel shall continue in
20 existence and advise the agency on matters outlined in this
21 subsection.
22 (8) The agency must ensure, in the first two state
23 fiscal years in which a risk-adjusted methodology is a
24 component of rate setting, that no managed care plan providing
25 comprehensive benefits to TANF and SSI recipients has an
26 aggregate risk score that varies by more than 10 percent from
27 the aggregate weighted mean of all managed care plans
28 providing comprehensive benefits to TANF and SSI recipients in
29 a reform area. The agency's payment to a managed care plan
30 shall be based on such revised aggregate risk score.
31 (9) After any calculations of aggregate risk scores or
2
3:52 PM 12/06/05 s0002Bc1c-wm25-j03
Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 923506
1 revised aggregate risk scores in subsection (8), the
2 capitation rates for plans participating under s. 409.91211
3 shall be phased in as follows:
4 (a) In the first year, the capitation rates shall be
5 weighted so that 75 percent of each capitation rate is based
6 on the current methodology and 25 percent is based on a new
7 risk-adjusted capitation rate methodology.
8 (b) In the second year, the capitation rates shall be
9 weighted so that 50 percent of each capitation rate is based
10 on the current methodology and 50 percent is based on a new
11 risk-adjusted rate methodology.
12 (c) In the following fiscal year, the risk-adjusted
13 capitation methodology may be fully implemented.
14 (10) Subsections (8) and (9) do not apply to managed
15 care plans offering benefits exclusively to high-risk,
16 specialty populations. The agency may set risk-adjusted rates
17 immediately for such plans.
18 (11) Before the implementation of risk-adjusted rates,
19 the rates shall be certified by an actuary and approved by the
20 federal Centers for Medicare and Medicaid Services.
21 (12) For purposes of this section, the term "capitated
22 managed care plan" includes health insurers authorized under
23 chapter 624, exclusive provider organizations authorized under
24 chapter 627, health maintenance organizations authorized under
25 chapter 641, the Children's Medical Services Network under
26 chapter 391, and provider service networks that elect to be
27 paid fee-for-service for up to 3 years as authorized under
28 this section.
29 (13)(7) Upon review and approval of the applications
30 for waivers of applicable federal laws and regulations to
31 implement the managed care pilot program by the Legislature,
3
3:52 PM 12/06/05 s0002Bc1c-wm25-j03
Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 923506
1 the agency may initiate adoption of rules pursuant to ss.
2 120.536(1) and 120.54 to implement and administer the managed
3 care pilot program as provided in this section.
4 (14) It is the intent of the Legislature that if any
5 conflict exists between the provisions contained in this
6 section and other provisions of this chapter which relate to
7 the implementation of the Medicaid managed care pilot program,
8 the provisions contained in this section shall control. The
9 agency shall provide a written report to the Legislature by
10 April 1, 2006, identifying any provisions of this chapter
11 which conflict with the implementation of the Medicaid managed
12 care pilot program created in this section. After April 1,
13 2006, the agency shall provide a written report to the
14 Legislature immediately upon identifying any provisions of
15 this chapter which conflict with the implementation of the
16 Medicaid managed care pilot program created in this section.
17
18
19 ================ T I T L E A M E N D M E N T ===============
20 And the title is amended as follows:
21 On page 2, line 30, through
22 page 3, line 6, delete those lines
23
24 and insert:
25 requiring the Secretary of Health Care
26 Administration to convene a technical advisory
27 panel to advise the agency in matters relating
28 to rate setting, benefit design, and choice
29 counseling; providing for panel members;
30 providing certain requirements for managed care
31 plans providing benefits to TANF and SSI
4
3:52 PM 12/06/05 s0002Bc1c-wm25-j03
Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. CS for SB 2-B
Barcode 923506
1 recipients; providing for capitation rates to
2 be phased in; providing an exception for
3 high-risk, specialty populations; requiring the
4 certification of rates by an actuary and
5 federal approval; providing that, if any
6 conflict exists between the provisions
7 contained in s. 409.91211, F.S., and ch. 409,
8 F.S., concerning the implementation of the
9 pilot program, the provisions contained in s.
10 409.91211, F.S., control;
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
5
3:52 PM 12/06/05 s0002Bc1c-wm25-j03